Explore pharmacist resources
Our number one priority is ensuring the health and safety of our members through access to over 65,000+ retail pharmacies.
What BIN number is used to adjudicate claims?
Our BINs 610852 and 610770 adjudicate on Capital Rx's platform. For additional information on these BINs, please consult the payer sheet for Capital Rx.
What do I do if a claim rejects?
Please call us at (888) 832-2779 and our support team will work with you to resolve the rejection as quickly as possible.
What do I do if I cannot confirm a member's eligibility?
Please call us at (888) 832-2779 and our support team will work with you to validate the member’s eligibility. If for any reason the issue cannot be resolved in real-time, please suggest that the patient pay for the prescription upfront and, once the eligibility error has been corrected, submit a paper claim to us. DMR form can be found here.
What should I do if a member thinks that his/her out-of-pocket obligation is incorrect?
Please call us at (888) 832-2779 to verify the patient pay amount.
How long does a prior authorization review take?
Most prior authorization reviews are completed within two business days provided that a complete prior authorization request form and all required documentation are correctly submitted. Our clinical team will notify you in advance of any declinations and assist in expediting your patient to a preferred alternative therapy.
How can I join the Capital Rx pharmacy network?
To join our network, please contact us at provider.relations@cap-rx.com.
Who do I contact for payment/remittance questions?
Please send your questions to ap@cap-rx.com.